Tonya N Taylor1, Curtis Dolezal, Susan Tross, William C Holmes. 1. Department of Psychiatrics, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA. tnt2109@columbia.edu
Abstract
CONTEXT: The rollout of antiretroviral treatment (ART) for the 25 million sub-Saharan Africans living with HIV/AIDS has been hampered by the lack of a western medical infrastructure. Given limited infrastructure, many Africans seek and receive HIV care from traditional African healers. This reality calls for culturally sensitive approaches to ART rollout that make use of local alternative health care providers, and an assessment of the potential quality of life (QOL) benefits of traditional African care (TAC) is imperative. OBJECTIVE: To examine changes in self-reported health status resulting from TAC and western medical care (WC). DESIGN, SETTING, AND PATIENTS: QOL in 254 consecutively sampled Zimbabwean patients seeking care at TAC and WC sites was assessed over 1 month. MAIN OUTCOME MEASURES: Shona translations of the HIV/AIDS-targeted QOL instrument and Medical Outcomes Study HIV Health Survey. RESULTS: After adjustment for baseline QOL scores and variables that differed across care sites, all dimensions of both instruments revealed QOL improvements only in the 155 (61%) patients from TAC sites when compared with the 99 (39%) patients from WC sites. These improvements were significant (P<or=0.01) for the HIV/AIDS-targeted QOL instrument dimensions of overall function, health worries, illness mastery, medication worries, and provider trust, and for the Medical Outcomes Study HIV Health Survey dimensions of general health perceptions, physical function, role function, pain, health distress, and energy/fatigue (range of regression coefficients, 10.0-18.3). CONCLUSIONS: Patients from TAC versus WC sites demonstrated significantly greater health status improvement across the majority of QOL dimensions assessed over 1 month. Though these data are from 1 rural community and capture only 1 month of disease progression, they strongly suggest that the potential benefit of integrating TAC sites in ART rollout programs-particularly in resource-poor settings-may go well beyond cultural sensitivity to impact on health itself and the likely related issues of ART adherence.
CONTEXT: The rollout of antiretroviral treatment (ART) for the 25 million sub-Saharan Africans living with HIV/AIDS has been hampered by the lack of a western medical infrastructure. Given limited infrastructure, many Africans seek and receive HIV care from traditional African healers. This reality calls for culturally sensitive approaches to ART rollout that make use of local alternative health care providers, and an assessment of the potential quality of life (QOL) benefits of traditional African care (TAC) is imperative. OBJECTIVE: To examine changes in self-reported health status resulting from TAC and western medical care (WC). DESIGN, SETTING, AND PATIENTS: QOL in 254 consecutively sampled Zimbabwean patients seeking care at TAC and WC sites was assessed over 1 month. MAIN OUTCOME MEASURES: Shona translations of the HIV/AIDS-targeted QOL instrument and Medical Outcomes Study HIV Health Survey. RESULTS: After adjustment for baseline QOL scores and variables that differed across care sites, all dimensions of both instruments revealed QOL improvements only in the 155 (61%) patients from TAC sites when compared with the 99 (39%) patients from WC sites. These improvements were significant (P<or=0.01) for the HIV/AIDS-targeted QOL instrument dimensions of overall function, health worries, illness mastery, medication worries, and provider trust, and for the Medical Outcomes Study HIV Health Survey dimensions of general health perceptions, physical function, role function, pain, health distress, and energy/fatigue (range of regression coefficients, 10.0-18.3). CONCLUSIONS:Patients from TAC versus WC sites demonstrated significantly greater health status improvement across the majority of QOL dimensions assessed over 1 month. Though these data are from 1 rural community and capture only 1 month of disease progression, they strongly suggest that the potential benefit of integrating TAC sites in ART rollout programs-particularly in resource-poor settings-may go well beyond cultural sensitivity to impact on health itself and the likely related issues of ART adherence.
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